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Elements and Performance Criteria

1. Calculate claim entitlement
   • Information is gathered and evaluated to determine the amount of loss suffered by the customer
   • Settlement terms are determined according to policy wording, legislation and codes of practice
2. Negotiate and communicate settlement terms
   • Terms and conditions of settlement offer are promptly advised to client and/or third party according to organisation claims procedures, where appropriate
   • Response by client and/or third party to terms of settlement offer is considered to assess whether adjustment is required to take into account the value of lost or damaged goods
   • Negotiation is undertaken in an endeavour to reach mutual agreement on valuation
   • Terms and conditions of settlement offer are modified as necessary and client and/or third party advised promptly
3. Document liability decisions
   • Claim decisions are clearly communicated to the relevant parties in a manner required by the policy wording, the legislation, organisation operating procedures and codes of practice
   • Decisions are documented in such a way as to determine the basis on which the decision was reached and all the evidence/information that was considered, where applicable
   • Claims documentation is sent to reinsurers
4. Finalise settlement
   • Once settlement is reached, payments are made/instructed within the required timeframe
   • Settlement release is obtained from client and/or third party, as applicable
   • Claim referred for recovery action if appropriate, and loss recovery agent appointed if applicable
   • Recovery action is initiated from reinsurers if applicable
   • Finalised claims files are stored and maintained according to organisation policy and legislative requirements and codes of practice, as applicable

Required Skills

Required skills

communication skills to determine and confirm information using questioning and active listening as required relate to customers liaise with others share information listen and understand use language and concepts appropriate to cultural differences numeracy and IT skills to perform calculations related to achieving required outcomes use computer applications word processing spreadsheet database specific purpose computer systems to assist in achieving required outcomes access and update records electronically access webbased information services literacy skills to read and interpret documentation from a variety of sources and record and consolidate relevant related information research and analysis skills for accessing and interpreting relevant information organisational skills including the ability to plan and sequence work

Required knowledge

accountability requirements level at which claim should be referred to senior staff organisation philosophy policy and procedures policy coverage relevant industry legislation

Evidence Required

The Evidence Guide provides advice on assessment and must be read in conjunction with the performance criteria required skills and knowledge range statement and the Assessment Guidelines for the Training Package
Overview of assessment
Critical aspects for assessment and evidence required to demonstrate competency in this unit	Evidence of the ability to apply organisation policy and procedures and comply with legislation and regulations and industry codes of practice
Context of and specific resources for assessment	Assessment must ensure competency is demonstrated in the context of the work environment and conditions specified in the range statement either in a relevant workplace or a closely simulated work environment access to and the use of a range of common office equipment technology software and consumables access to organisation records access to organisation policies and procedures
Method of assessment	A range of assessment methods should be used to assess practical skills and knowledge The following examples in combination are appropriate for this unit evaluating an integrated activity which combines the elements of competency for the unit or a cluster of related units of competency observing processes and procedures in workplaces verbal or written questioning on underpinning knowledge and skills evaluating samples of work accessing and validating third party reports
Guidance information for assessment

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Range Statement

The range statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Bold italicised wording, if used in the performance criteria, is detailed below. Essential operating conditions that may be present with training and assessment (depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts) may also be included.
Customer may be:	a third party an agent or a lawyer acting for the client the client.
Settlement terms may include:	cash settle ex gratia payments repair replace total loss vouchers.
Claim decisions may be:	cancellation of claim (excess greater than settlement) need further details partial settlement payment repair approval replacement approval.
Recovery action may include:	determining financial status of third party determining liability of third party recovery from reinsurers salvage.
Storage of data may be:	electronic or hard copy (paper).

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